Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study
Allen C Cheng,
Helen Marshall,
Monsurul Hoq,
Christopher C Blyth,
David Burgner,
Davinder Singh-Grewal,
Jim Buttery,
Nicholas Wood,
Joshua Reginald Francis,
Jeremy Carr,
Kristine Macartney,
Danielle Wurzel,
Julia E Clark,
Brendan McMullan,
Nigel W Crawford,
Shidan Tosif,
Philip N Britton,
Alissa McMinn,
Nicole Dinsmore,
Anne Kynaston,
Ryan Lucas
Affiliations
Allen C Cheng
Infection Prevention and Healthcare Epidemiology Unit, Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
Helen Marshall
2 Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
Monsurul Hoq
Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Christopher C Blyth
Wesfarmers Centre of Vaccines and Infectious Disease, Telethon Kids Institute and School of Medicine, University of Western Australia, Perth, Western Australia, Australia
David Burgner
Murdoch Children`s Research Institute, The Royal Children`s Hospital, Parkville Victoria, Australia
Davinder Singh-Grewal
School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
Jim Buttery
Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Nicholas Wood
National Centre for Immunisation Research and Surveillance, The Children`s Hospital, Westmead, New South Wales, Australia
Joshua Reginald Francis
Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Dili, Timor-Leste
Jeremy Carr
Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK
Kristine Macartney
1 National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
Danielle Wurzel
11 Department of Respiratory and Sleep Medicine, The Royal Children`s Hospital Melbourne, Parkville, Victoria, Australia
Julia E Clark
Infectious Diseases, Children`s Health Queensland Hospital and Health Service, Herston, Queensland, Australia
Brendan McMullan
2 Department of Infectious Diseases, Sydney Children`s Hospital Randwick, Randwick, New South Wales, Australia
Nigel W Crawford
Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Shidan Tosif
Infection and Immunity Theme, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
Philip N Britton
Department Infectious Diseases and Microbiology, Children’s Hospital Westmead, Sydney, New South Wales, Australia
Alissa McMinn
SAEFVIC, Infection and Immunity, Murdoch Children`s Research Institute, Parkville, Victoria, Australia
Nicole Dinsmore
National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Westmead, New South Wales, Australia
Anne Kynaston
Queensland Children`s Hospital, South Brisbane, Queensland, Australia
Ryan Lucas
General Medicine, Children`s Hospital at Westmead, Westmead, New South Wales, Australia
Objective To present Australia-wide data on paediatric COVID-19 and multisystem inflammatory syndromes to inform health service provision and vaccination prioritisation.Design Prospective, multicentre cohort study.Setting Eight tertiary paediatric hospitals across six Australian states and territories in an established research surveillance network—Paediatric Active Enhanced Disease (PAEDS).Participants All children aged <19 years with SARS-CoV-2 infection including COVID-19, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and Kawasaki-like disease TS infection (KD-TS) treated at a PAEDS site from 24 March 2020 to 31 December 2020.Intervention Laboratory-confirmed SARS-CoV-2 infection.Main outcome Incidence of severe disease among children with COVID-19, PIMS-TS and KD-TS. We also compared KD epidemiology before and during the COVID-19 pandemic.Results Among 386 children with SARS-CoV-2 infection, 381 (98.7%) had COVID-19 (median 6.3 years (IQR 2.1–12.8),53.3% male) and 5 (1.3%) had multisystem inflammatory syndromes (PIMS-TS, n=4; KD-TS, n=1) (median 7.9 years (IQR 7.8–9.8)). Most children with COVID-19 (n=278; 73%) were Australian-born from jurisdictions with highest community transmission. Comorbidities were present in 72 (18.9%); cardiac and respiratory comorbidities were most common (n=32/72;44%). 37 (9.7%) children with COVID-19 were hospitalised, and two (0.5%) required intensive care. Postinfective inflammatory syndromes (PIMS-TS/KD-TS) were uncommon (n=5; 1.3%), all were hospitalised and three (3/5; 60%) required intensive care management. All children recovered and there were no deaths. KD incidence remained stable during the pandemic compared with prepandemic.Conclusions Most children with COVID-19 had mild disease. Severe disease was less frequent than reported in high prevalence settings. Preventative strategies, such as vaccination, including children and adolescents, could reduce both the acute and postinfective manifestations of the disease.
